Herpes, Genital

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Description

  • Chronic, recurrent herpes simplex virus (HSV) type 1 (HSV-1) or 2 (HSV-2) infection of any area innervated by the sacral ganglia
  • HSV-1 primarily causes anogenital and orolabial lesions; HSV-2 typically causes anogenital lesions. However, HSV-1 is now the leading cause of new genital infections (1).
  • Primary episode: initial infection, no preexisting antibodies to HSV-1 or HSV-2 (may be asymptomatic)
  • First episode, nonprimary: initial genital eruption; preexisting antibodies are present.
  • Reactivation: recurrent episodes
  • Synonym(s): herpes genitalis

Epidemiology

  • Most commonly infected from age 15 to 30 years; prevalence increases with age due to cumulative exposure.
  • HSV-2: females infected 2 to 3× > males
  • United States: HSV-1 infectivity highest in Mexican Americans and HSV-2 highest in non-Hispanic Black individuals

Incidence

  • Incidence in the United States is estimated to be ~572,000 to 1.6 million new cases per year; highest in 18- to 24-year-olds.
  • Incident genital HSV infections globally in 2020 among individuals aged 15 to 49 years was estimated at 42.4 million.

Prevalence

  • Globally, in 2020, genital HSV-1 and HSV-2 infections were estimated at 846.1 million people aged 15 to 49 years.
  • HSV-1 infects an estimated 3.7 billion people, and HSV-2 infects about 491 million people globally, representing 67% and 13% of the population between 15 and 49 years old, respectively (1).
  • Between ages 14 and 49 years, the prevalence of HSV-1 in the United States is ~48% and the prevalence of HSV-2 is ~12%.
  • HSV-2 prevalence is estimated at 60–95% in the HIV-positive population (2).
  • Up to 90% of those who are seropositive lack formal diagnosis.

Etiology and Pathophysiology

  • HSV is a double-stranded DNA virus of the Herpetoviridae family (2).
  • Spread via genital-to-genital contact, oral-to-genital contact, and via maternal–fetal transmission.
  • Incubation is 4 to 7 days after exposure.
  • Risk of transmission highest when lesions are present.
  • Viral shedding is possible in the absence of lesions, increasing the risk of transmission due to inadequate barrier/abstinence precautions.
  • Viral shedding occurs intermittently, unpredictably, and more commonly with HSV-2.
  • HSV infection increases the risk of HIV.

Risk Factors

  • Risk increases with age, number of lifetime partners, history of sexually transmitted infections (STIs—particularly HIV), sexual encounters before the age of 17 years, and partner with HSV-1 or HSV-2.
  • Infection with HSV-1 confers 3-fold risk of infection with HSV-2.
  • Immunosuppression, fever, stress, hormonal shifts, sun exposure, dietary intake and trauma increase risk of reactivation.

General Prevention

  • Barrier contraception and avoiding sexual contact when symptoms/lesions are present.
  • Abstinence is the only means of complete protection.

Commonly Associated Conditions

Syphilis, HIV, chlamydia, gonorrhea, other STIs

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